Final Week

This week I was on rotation in rheumatology, neurology, and geriatrics. The first day in the wards, we saw a rheumatology patient. He hadn't been diagnosed yet, so the students were able to perform an examination on him to determine what the problem was. The exam was checking for rheumatism and tendinitis, and they came to the conclusion, based on his painful and swollen joints, that he had both osteoarthritis and rheumatoid arthritis. This was the patient that they selected for this week's case presentation.  That same day, we also saw two neurology patients. The first suffered from a spinal lesion and we learned how to properly do a neurological examination to determine where exactly the lesion was located, which ended up being C7. The next patient also had a spinal lesion and it was determined by her scans that the lesion was C2, which was the result from being stabbed in the neck. The next day, we returned to the rheumatology ward in order to collect a history for the presentation on Friday. Because they had performed the rheumatology exam the previous day, this time it was a general exam to see if there were any additional problems. We then saw another neurology patient who had been diagnosed with myopathy. She could not walk or lift her arms. We learned how to do proper reflex tests and what each test tells us, and we also learned how to test muscles for tone and power to determine the severity of the myopathy. The following day, we spent the morning performing a comprehensive geriatric assessment, that tested vision, balance/coordination, cognition, and various other skills. We then discussed with the geriatrician what each test was assessing and what the results mean. The last morning, we began the day by listening to doctors from each department present an interesting patient that they had recently encountered. The cardiologist showed us an echocardiogram and an electrocardiogram of a patient that had been diagnosed with cardiomyopathy. The neurologist had a patient with an extremely rare neurological disorder called opsoclonus myoclonus ataxia, which has a very low occurrence, only affecting about 1 in ten million people per year. The patient had extremely unusual eye movements as well as an abnormal gait, as seen in the video of the patient that the doctor showed us. The pulmonologist presented a patient that was diagnosed with superior vena cava syndrome, which is caused by an obstruction of the superior vena cava. After the doctors' presentations, each rotation group had their own presentations, and then we returned to the hospital to perform a hand examination on an arthritic patient.

Classes this week were also quite interesting. On Monday we had endocrinology and we discussed hypo and hypercalcemia, the roles of calcium and calcitonin in the body, components of the adrenal gland, Addison's disease, and the effects of aldosterone, cortisol, and androgens. We also had cardiology where we learned about the anatomy of the mitral valve and its diseases, such as mitral valve stenosis and mitral regurgitation. Tuesday we had radiology in which we learned about the protocol for performing and interpreting a chest x-ray. We also had a lecture on pediatrics that I really enjoyed. We talked about what pediatrics is and how it differs from adult medicine in terms of communication difficulties, technical challenges, embryology, growth, development, preventative medicine, and the mother-child bond. The lecturer told us all about how to approach children and what to do and what not to do when examining a child. We also learned about child nutrition, physical growth, and growth standards. On Wednesday, we had a surgery lecture that covered vascular diseases such as arterial insufficiency, peripheral arterial disease, acute ischemia, gangrene, aneurysm, and varicose veins. We also learned about disease of the stomach and duodenum, peptic ulcer disease, the effects of NSAIDs and gastrointestinal bleeding. On Thursday we had a lecture about fetal monitoring and distress and then a lecture on the ophthalmic examination, which included visual acuity, visual field testing, color vision, and ocular motility. Friday's lecture consisted of learning the basis of quality in health care delivery, and what quality actually means in terms of treating patients. Our afternoon lecture was quite short, but we covered thoracic trauma which involves the lungs, heart, and esophagus. The injuries that we talked about were tension pneumothorax, pulmonary contusion, hemothorax, and cardiac tamponade. Class was dismissed early and a few of us went out to spend our last night here at a wine tasting where we got a chance to try a wide array of local wines, which I think was a very pleasant way to end our trip.

In a few hours, we'll be headed home, which is quite bittersweet. These last few weeks have been so incredible and I'm really thankful that I was able to come on this trip. Even though a lot of the information that we covered both in class and on rotation went over my head, sitting in on these lectures has made me so excited to be in medical school and actually learn all of this for myself. The hospital rotations were also great because it gave me a chance to see first-hand some of the conditions that I've only ever read about and never actually witnessed. While it is a little disappointing that I didn't see any new trauma patients, despite being on call a few times, it was probably a good thing that people weren't getting that badly injured. I'm also very thankful for the people that I've met here because everyone has been so friendly and welcoming and although I am ready to be home, I'm sad about leaving. Overall this trip was a little disorganized and we did get off to a rocky start, but once we actually got into the medical side of things, everything ended up working out. I look forward to the day when I can come back to South Africa because it really was an amazing experience.

Last Full Weekend

Friday
Today each group had to present one of the patients they had seen on rotation this week. They had to compile all the data they had collected from their examination, the patient's chart, and their verbal history. I was able to listen to both my group from cardiology and the group from gastroenterology. We also had a lecture about antibiotic resistance and the effects of vaccines. After lecture, we had a short break before our next class. I got some lunch and then came back for a lecture on how to manage the health of various age groups. We also talked about how each age group, whether it's infant, toddler, school-aged child, etc., has different health risks and therefore require different management of their health. Our last class was about trauma and we covered a brief history and general overview of trauma. Trauma is organized into phases and hospitals are ranked 1 through 4 based on their level of preparedness and ability to treat trauma patients. The surgeon who was lecturing today also said that the medical aspects of Grey's Anatomy are actually fairly accurate, which is exciting for me because it's one of my favorite shows. We then talked about resuscitation physiology, hypothermia, shock, and metabolic responses to trauma. Later on in the evening, I went back to Pelonomi with some of the Afrikaans students for their 12 hour on-call shift. We were supposed to go into surgery when trauma patients came in, but no patients came and we ended up being sent home after an hour. As of now, I'm 0 for 2 on seeing anything happen while on call. I did, however, learn to tie a surgical knot, so at least I learned something while I was there! I plan on going back sometime next week in the hope that maybe I'll get to see at least one patient.

Saturday
Today was a very busy day. Since this was our last full weekend here, we wanted to do something that was unique to Africa. We decided to go to Bagamoya Wildlife Estate because they allow people to come in and interact with the animals. Once we got there, we went into the fence and got to play with a 3 month old lion cub named Napoleon, but everyone called him Napo. He was probably one of the cutest animals I've ever seen and he was so playful. He loved playing with the strings of one of the volunteer's backpacks, and he also really enjoyed playing with a tennis racket. In his enclosure, there were also about six Jack Russel Terriers. The reason the dogs are in with the lion cub is so that he has someone to socialize and play with because he's too small to play with the older lions. After we played with him for awhile, we then got to feed him. We bottle-fed him a mixture of cat food and water and then we each got to give him a few chunks of raw meat as well. In order to get him to eat the food, we had to hold it on the side of his mouth so he could just turn his head and take the meat from our hands. It was a really amazing experience. After Napo, we then went into the enclosure that had two lions and two tigers, each about six months old. Even though they were relatively young, they were still massive creatures. I was bottle feeding one of the tigers and he knocked me down to the ground and was practically standing on top of me while the other tiger was trying to grab my leg. They are very playful animals and have grown up around humans, so I wasn't afraid that they were trying to attack me. They were just trying to play with my but I don't think they realized how much stronger they are than me. A little while later I was standing with my back to a fence and one of the tigers jumped up and had it's paws on my shoulders. He was so huge and so strong and I only wish that I was strong enough to actually play with him instead of just letting him push me around. It was so incredible to be able to feed and play with such amazing animals and I'm really glad we had the opportunity to do so. After we left Bagamoya, we went to our friend Inge's place for lunch before we went to a pub to watch the South African rugby team play. I don't really follow rugby, nor do I know what's going on half the time, but it was a good game to watch. South Africa ended up losing to New Zealand, but it was a close match. We ended the night by going to a friend's birthday party. It was a nice chance to get to know some of the other med students that I hadn't met yet.

Sunday
Today was a more relaxing day, but it was still very enjoyable. It's Josh's birthday so we all met this morning for brunch, which was quite nice. One of the girls baked a carrot cake and it was easily one of the most delicious cakes I've ever had. We then went back to our friend Jacques' place so we could watch a Formula 1 race. I don't typically follow F1, so I wasn't sure who to cheer for, but it was still fun to watch. Just as the race had ended, the power went off yet again. Load shedding has been quite and inconvenience these past few weeks, but at least it happened at the end of the race instead of at the beginning. After spending a few hours at Jacques', I came back to my room and had a relaxing evening spent watching a movie and getting some more work done on my paper. It's hard to believe that I've already been here for three weeks and that it's almost time for me to go home. I've had a lot of fun so far this month and I've learned so much about medicine and becoming a doctor. I hate that I only have a few days left before leaving, but I'm sure they're going to be great!

 Baby Napoleon

 Jon feeding Napo

 Zack and Napo playing with a tennis racket

 This happened to me, too

 Bottle-feeding a six moth old lion

 This is the moment right before he jumped on me

Jon playing tug-of-war with a lion

July 22nd and 23rd

Wednesday

Today during our cardiology rotation, we visited a patient that we had seen previously in order for the students to collect a full history and perform an examination. On Friday my group has to present one of the patients we've seen this week, and in order to do so we'll need to collect all the information we can. We spoke with the cardiologist and he told us all about different heart lesions, what causes them, and what effects they have on heart function. A lot of the information we're given and most of what the students are expected to know goes over my head. I know I'm not expected to know exactly what's going on physiologically, but it would be nice if I was able to participate in discussions more. In the pulmonology session, we learned what to check during an exam, such as trachea location and chest expansion. We then had lecture on pediatrics and learned about fetal physiology and hypothyroidism. After lunch we learned about orthopedic trauma. We talked about various pediatric fractures and remodeling, and then went into orthopedic infections in children. The two infections that we covered were osteomyelitis, which is an infection of the bone marrow, and septic arthritis. After class, I spent the evening gathering sources to start writing the research paper that I have due once classes start.

Thursday

During today's cardiology session, each of the students in my group examined the patient and were then asked questions about what they heard. They were asked to listen to the heart sounds and determine what sort of lesion the patient had. The doctor that was questioning them was extremely intelligent, but also fairly intimidating. The next session we had was pulmonology and the students were able to palpate a patient's abdomen in order to find any masses. They used different exam techniques to determine where the mass was and whether or not it was in a fixed location. They also had techniques to test ascites, which is a buildup of fluid in the peritoneal cavity that causes abdominal swelling. After our two sessions, the group met up to prepare for the presentation that they have tomorrow. It was nice to see that eight people could work together so easily. They were bouncing ideas off of each other and coming to consensuses fairly quickly. After they finished the preparation for the presentation, we all went to class. Today's lecture was in obstetrics and we went over what is called an H10 card. An H10 card is assigned to each pregnant woman and it is a form that details all of her pregnancy information, including general details about her health and any exam results. We also talked a lot about antenatal care and ultrasound screening. After class, a few of us were planning on going to dinner at the mall because there was a restaurant that had inexpensive bottomless pizza. Once we got to the mall and put in a request for a table, the power went out because of more load shedding. We were hoping that the restaurant had a wood-burning oven so that they could still make pizza without power, but we weren't so lucky. We ended up going to another pizza place and spent a pleasant evening just hanging out and eating pizza together. On a not-so-pleasant note, I've developed a sore throat and a slight cough. It's not too bad, just more of an inconvenience. I do, however, have throat lozenges that I've been using, so hopefully I'll be feeling better soon!

July 20th and 21st

I have extremely spotty internet in my room and last night it took nearly an hour just to get one page to load, so that's the reason for the delay. Yesterday we began rotation at Universitas hospital. I was with the group that went to cardiology. We saw one patient who had previously had a heart attack and when he came for a routine follow-up, it was discovered that he had a heart murmur as well. The doctor came in and was telling us about the different types of murmurs and how to identify them. I learned that there are four things you must check for when listening for a murmur and they are timing, volume/pitch, area of greatest intensity, and whether or not the murmur can be heard in other areas. The next patient had a collapsing pulse, which means that his radial pulse is weaker when the arm is lowered and stronger when the arm is raised. We didn't have time for the students to get a history or perform an examination, but the plan is to go back and see him again later in the week. We then got a chance to listen to what each heart sound and murmur is supposed to sound like with the help of a simulated patient. I was able to listen to the different murmurs and while I couldn't identify them, I could definitely hear a difference in each one. It was fun getting a chance to experiment with different heart sounds and feel for each pulse. Later on we went to hematology lecture and discussed the mechanism and effects of aspirin and NSAIDs. We also talked a lot about various bleeding disorders, how they occur, and what can be done to treat them. After class I talked with the woman who was in charge of my building to figure out a plan for me and I am now in the room that I will be in until I leave. The room itself is fine, it's just quite chilly and the internet is very unreliable, but I'm happy to finally be settled. I have a roommate now, and she is also an international student. She is from the Netherlands and will be here studying law for this entire semester. I actually met her last weekend and she's very friendly. We had our first building-wide meeting last night. It was mainly a welcome back kick-off to a new semester. The building I'm in is just girls and the guys from the building next door actually came over and serenaded us, which was very entertaining. The girls here have been really kind and welcoming as well.

Today I was with the same group and we began the day in the pulmonology ward. As soon as we got there, our group was split in half and were each assigned to a patient. Together, each group performed a full respiratory examination on their respective patients. They were left to examine the patient without the help of any doctors or more experienced students, and it was really interesting to watch them figure out what to do on their own. It was an opportunity to put to use what they had been studying for the past two years and it makes me excited to do that myself someday. After the examination, they compiled the signs and symptoms and presented them to the doctor. We then had a short break before going to the cardiology ward. Yesterday we received a list of interesting cases that we should go take a look at if we had time. We went to see a teenager who had Graves disease, but she had already been discharged by the time we got there. We tried seeing another patient from the list, and when we got to his room we learned that he had just been transferred to another hospital, so we didn't get to see him either. We then went back to the cardiology ward and spoke with the head of the department. She told us all about cardiomyopathy, what causes it, what effects it has, and how to diagnose and treat various heart conditions. It was incredibly informative, but it was also a lot to take in. She's a brilliant woman and it's evident that she genuinely cares about the students' learning. After cardiology, we had lecture on radiology. We talked about the different types of screening and diagnostic imaging, such as CT scans, mammography, MRI and ultrasound. I got lunch in the cafeteria and then went back to class for a pediatric lecture. Today we learned about fetal physiology, hypothyroidism, and neonatal jaundice. I'm learning so much through the hospital rotations and through attending lectures, and it's making me excited to actually be in medical school and start becoming a doctor. This evening, I went with my roommate to join the other international students and we cooked dinner together and then spent some time chatting. I'm very much enjoying spending time with the international students, and I'm glad that I've made some other friends.

July 18th-19th Weekend

Yesterday I slept in a bit later than I was expecting, but I still had the opportunity to get out and do something. Jon was on-call in the trauma unit all day, so Zack and I shopped around the festival for a while and each got some great souvenirs. For lunch I had another ostrich burger because they are very delicious and I'm sad that we don't have them in the States. After lunch, Zack and I walked to Mimosa Mall. It was less than ideal because when we got there, the mall was experiencing load shedding, which is when the city shuts off power to specific areas for two hours. We first had difficulty crossing the street to get to the mall because the street lights were out as well and people rarely stopped long enough for us to cross. Once inside the mall, all the lights were off and all the stores had their gates closed. It was very warm in the building because the air was off as well, so we went to buy drinks, only to be turned away because no restaurant had a working computer system. We ended up just heading back to campus with the idea of coming back when the power was on. Later that day, we met up with the other international students. There are four people from the Netherlands, one from France, one from Russia, two from Italy, and four from Germany. We all met for dinner and spent some time together at the festival before going out dancing. It was really nice getting to meet some of the other International Students.

Today I had a bit of a rough start. I was woken up at 9 by the girl whose room I had been staying in. She told me that she didn't know where I was supposed to go, but I needed to be out of the room by 10, so I had an hour to pack up all my things and then find somewhere else to go. I ended up sitting in the lobby with all of my stuff just waiting for somewhere else to stay. No one seemed to know what was going on. They ended up putting me in another temporary room, but I'm not sure how long it's going to be before they move me yet again. It's tiresome having to keep moving and not really know what's going on, but I haven't been dwelling on it too much. After I switched rooms, I met up with Zack, Jon, and some of the other internationals and we walked to the mall and got lunch at a restaurant called Mugg and Bean. I read through the menu and it seemed too familiar, and then I realized it was started by two Americans. At first I didn't think anything of pulled pork barbecue, coleslaw, and the word fries instead of chips because I'm so used to those things from back home. The food was really good and I would definitely enjoy going back because there were so many options that I wanted to try. After lunch, we went to Naval Hill. which, as the name implies, is a big hill located inside a small game reserve. At the top of the hill, there was a statue of Nelson Mandela and amazing panoramic views of Bloemfontein. Because the area is a game reserve, we got the chance to see some animals. We saw a pack of wildebeest and got up close and personal with a few zebras. I was so excited that these animals are so calm and used to humans that you can stand so close to them and they don't go anywhere. There were also a few giraffes on the reserve, but sadly we didn't see any. We may go back again to try and see some because giraffes are my favorite animal. I took a few pictures and I'm glad I finally got a glimpse into the wild Africa that I was really hoping to see!

Panoramic shot of Bloem from Naval Hill

Nelson Mandela Statue

Zebras!

My favorite picture from today.

Zebra Selfie

Pack of Wildebeest

July 17th

Today we had lecture with a professor who enjoys picking on students. Each class he picks a few students and bombards them with questions throughout the entire class period. Somehow, he managed to learn my name, so I had the unfortunate pleasure of being one of the few who was put on the spot the whole class. I was sitting in the back row and then just as class was starting I heard someone calling my name from the front of the room. I perked my head up and that's when it all started. I didn't even know this professor knew my name because I hadn't introduced myself to him yet. I think he enjoys calling on people who don't know the answer, because we were talking all about South African legislature and the National Health Act of 1977, both of which I know next to nothing about. He was friendly enough, but I really don't like being called on when I don't know the answer, so I didn't very well like this particular lecture. I did end up learning a lot though, so I guess it all worked out in the end. The next lecture we had was about trauma. We went over the process of treating trauma patients, and the proper way to assess a new patient. We learned the mnemonic ABCDE to help us remember what to look for first: airway, breathing, circulation, disability, and exposure/environment. After class we had a little while to relax and then we met for dinner at the festival and I got another ostrich burger because they're delicious. This weekend we plan on seeing some wildlife and maybe do some shopping, and then Monday we're going back to the hospital to begin our rotations!

July 16th

Today in class we were split up into the groups that we'll be rotating with for the next few weeks. Given that Jon, Zack, and I are only here for two more weeks, and each rotation is a week long, we're allowed to join whichever group we please. There are seven different specialties they're rotating through, and the first I plan on seeing is cardiology/pulmonolgy, which should be pretty interesting. After sorting out groups, we had a lecture on geriatrics. We talked a lot about comprehensive geriatric assessment, who all is involved in geriatric care, and what sort of tests should be done during the assessment. Comprehensive geriatric assessment focuses on four aspects that each cover a wide variety of factors. We learned a lot about geriatric care and the benefits of comprehensive assessment. The next class we had was ophthalmology. The students had a quiz to start class, and I took it as well, even though I'm not actually in the class. It had about eight questions, and having had essentially no experience in ophthalmology, I made educated guesses on just about every question. After the quiz, we learned about nearsightedness and farsightedness and discussed the procedure behind LASIK surgery. After that class, we went to the festival again for lunch and I tried something new yet again. Today I tried skaapsterjie which is Afrikaans for sheep tail. It was pretty fatty and there wasn't a lot of meat on each piece, but it had a good flavor. After lunch we had obstetrics lecture and talked about various physiological changes of each organ system that occur during pregnancy. Later on in the evening, we went to the festival for dinner and to see some live music. There was one woman who played violin to popular songs and she was very talented. We met with some more medical students who were very excited to have finally met an American. This festival has been very enjoyable and I'm glad that it's given me the opportunity to try a variety of South African foods and get to see some local artists. The festival is here all weekend, so I'm excited to get to try even more new food!